16. THORACIC FRACTURES AND OTHER CHEST WALL ABNORMALITIES AFTER THORACOTOMY FOR ESOPHAGEAL CANCER: A RETROSPECTIVE COHORT STUDY

Abstract

Chest wall pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. The aims of this study were 1) to determine the prevalence of chest wall abnormalities on postoperative imaging; and 2) to compare complications, long-term pain, and quality of life in patients with versus without thoracotomy-related thoracic fractures. This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 1 January 2010 and 31 December 2020. An early postoperative CT (<1 month) and/or late CT (>6 months) had to be available. Disease-free patients were asked to complete questionnaires on pain and quality of life (SF-36 and EORTC-QLQ-C30). A total of 366 patients were included. Thoracotomy-related rib fractures were seen in 144 (39%) patients and thoracic transverse process fractures in 4 (2%). Patients with thoracic fractures more often developed postoperative complications (89% versus 74%, p = 0.002), especially pneumonia (51% versus 39%, p = 0.032). Seventy-seven participants (33 with thoracic fractures, 44 without) completed questionnaires median 41 (P25-P75 28–91) months postoperatively. Long-term chest wall pain was reported by 48 (63%) participants but no association with thoracic fractures was found (p = 0.637). Quality of life scores did not differ between patients with versus without thoracic fractures and were mostly comparable with their reference populations. Thoracic (mainly rib) fractures are prevalent following a thoracotomy for esophageal cancer. Patients with thoracic fractures have an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or decreased quality of life was not confirmed.